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Abstract:

Background: Anxiety and depression are common in older people but are often missed; to improve detection
we must focus on those elderly people at risk. Frailty is a geriatric syndrome inferring increased risk of poor
outcomes. Our objective was to explore the relationship between frailty and clinically significant anxiety and
depression in later life.
Methods: This study had a cross-sectional design and involved the assessment of 567 community-dwelling
people aged ?60 years recruited from the Technology Research for Independent Living (TRIL) Clinic,
Dublin. Frailty was measured using the Fried biological syndrome model; depressive symptoms were assessed
using the Center for Epidemiological Studies Depression Scale; and anxiety symptoms measured using the
Hospital Anxiety and Depression Scale.
Results: Higher depression and anxiety scores were identified in both pre-frail and frail groups compared to
robust elders (three-way factorial ANOVA, p ?0.0001). In a logistic regression model the odds ratio for
frailty showed a significantly higher likelihood of clinically meaningful depressive and anxiety symptoms even
controlling for age, gender and a history of depression or anxiety requiring pharmacotherapy (OR = 4.3; 95%
CI 1.5, 11.9; p = 0.005; OR = 4.36; 95% CI 1.4, 13.8; p = 0.013 respectively).
Conclusions: Our findings suggest that even at the earliest stage of pre-frailty, there is an association with
increased symptoms of emotional distress; once frailty develops there is a higher likelihood of clinically
significant depression and anxiety. Frailty may be relevant in identifying older people at risk of deteriorating
mental health.